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Thomas Clinch, MD EW San Francisco 2013 3 Precision, ease-of-use, reliability: Why I use the WaveLight FS200 by Thomas Clinch, MD Integrating new technology into a practice for optimal outcomes " What I have found advantageous on the FS200 over other lasers is its ability to optically measure the thickness of each interface to ensure that when the LASIK flap is cut, it's precisely at the depth the surgeon needs. " R efractive surgeons have the envy of most other subspecialties—our out- comes are precise, our patients are thrilled, our complication rates are minute … but still we do not rest on our laurels. The WaveLight FS200 (Alcon, Fort Worth, Texas) combines the fastest femtosecond laser on the market (200 Hz) with consistently repro- ducible results. With this laser, I've been able to create flaps in approxi- mately 6 seconds.* I've had patients tell me the time they were under the WaveLight FS200 laser was less than the time it took them to put in their contact lenses in the morning. The faster we're treating patients, the less likely it is there will be patient movement, and therefore, we have much more precise flaps and fewer imperfections. While we haven't conducted an approved clinical trial comparing lasers, anecdotally we have con- ducted small interoffice comparisons among our refractive surgeons. In our experience, none of us has been off by more than 5 microns. Unique capabilities While all femtosecond lasers use an interface, and they are supposed to be calibrated to a specific thickness, that has not always been the case. What I have found advantageous on the FS200 over other lasers is its abil- ity to optically measure the thick- ness of each interface to ensure that when the LASIK flap is cut, it's precisely at the depth the surgeon needs. As refractive surgeons, we know how critical that can be when treating patients with thinner corneas or higher levels of refractive error. Earlier versions of femtosecond lasers would have issues shrinking the flap size when the eye was not perfectly planar. So, for example, if I planned on an 8.5 mm diameter flap but the patient moved his/her eye before I achieved good suction, the flap might only be 8 mm, or 7.9 mm. That, in turn, meant that I did not have a large enough diameter to fit the entire ablation. With the FS200, though, once I've applanated the eye, I'm always able to get the diameters I need. In my hands, I've found spherical myopic patients are best treated at 8.2 to 8.5 mm flaps, myopic astigmates are best treated at 9 mm flaps, and hyperopes are best treated at 9.2 mm flaps. This laser optimizes both spot size and line spacing to achieve those consistent results. No laser system will be able to applanate every patient. While rare, there will be that unusual patient with an odd orbital configuration or an inability to remain still. I found it's not uncommon to have patients squeeze their eyes or move their eyes around. With older femtosecond lasers, I was never confident my de- sired flap size would be achieved— until now. With the FS200, the unique suction ring design inte- grated adjustable features that have been shown to minimize ocular distortion and intraocular pressure spikes, and automate vacuum con- trol. 1 For the latter, vacuum control is provided via a computer instead of the typical syringe. Opaque bubble layers All femtosecond lasers create opaque bubble layers (OBL) to some degree continued on page 4 The laser-cut channel helps eliminate opaque bubble layers (OBLs). Source: Alcon A flap bed and edge, each at 100x magnification Source: Alcon Alcon Sunday_SF2103 8pages-DL2_Layout 1 4/20/13 8:12 PM Page 3

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